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Neurology > Neuro Emergencies > Flashcards

Neuro Emergencies Flashcards

1
Q

Head Trauma- history

A 
When, where & how
Mechanism of injury
LOC at the scene
Alcohol/drug involvement
Length of time from injury
Underlying medical problems
Allergies
Medications
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2
Q

Head trauma- physical

A 
Vitals
Glasgow coma scale
Examine for outward trauma
C-spine collar
Pupils
Level of alertness
Look for focal deficits
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3
Q

Clinical features of TBI

A 
\+ or - LOC, confusion or amnesia (legnth)
Headache
Dizziness, vertigo, imbalance
Disorientation
N/V
Vacant stare
Inability to focus
Gross incoordination
Memory deficits
Delayed verbal expression
Slurred or incoherent speech
Labile emotions
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4
Q

Complicated TBI issues

A 
Post-traumatic seizures
Focal neurologic signs
Neurologic deterioration
Worsening HA, confusion, focal neurological signs or lethargy
Other injuries to H&N
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5
Q

Guidelines for CT Scan in ER

A

GCS

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6
Q

CT scan abnormalities that require consult

A

Subdural hematoma
Intracranial bleeding
Cerebral edema
Significant skull trauma

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7
Q

Hospitalization or transfer

A

GCS

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8
Q

Outpatient observations warning signs

A 
Inability to wake patient
Severe or worsening HA
Somnolence/confusion
Difficulties with vision
Incontinence
Weakness/numbness
Unsteadiness or seizure
Vomiting, fever, stiff neck
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9
Q

Clinically significant skull fractures

A

Pass through sinus
Associated with scalp lesion
Depressed below the level of the skull’s inner table
Overlie a major dural venous sinus or middle meningeal artery

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10
Q

Depressed Fractures

A

Difficult to review on radiographs

Often can be felt

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11
Q

Basilar fractures

A

Linear fractures
Usually through the temporal bone
Fracture causes dural tear
CT for imaging

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12
Q

Signs of basilar fracture

A

Raccoon eyes
Battle’s sign
Hemotympanum

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13
Q

Definition of open skull fractures

A

An overlying scalp laceration and the dura is disrupted

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14
Q

Primary Headaches Syndromes

A

Migraines
Cluster HA
“Worst HA ever”

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15
Q

Characteristics of migraines

A 
Unilateral
Throbbing
Aura
Hx of migraines
N/V
Photophobia
Sound sensitive
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16
Q

Treatment of migraines

A

1st- Tryptans
2nd- Ketorolac + antiemetic
IV fluids

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17
Q

Characteristics of cluster HA

A

Men
Excruciating pain behind eye
Hx of cluster HA
Snot running out of nose

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18
Q

Treatment of cluster HA

A

1st- 100% oxygen

2nd- Sumatriptan

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19
Q

Thunderclap HA

A

Associated with N/V

+/- focal neurologic findings

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20
Q

Life threatening causes of HA

A 
Subarachnoid Hematoma
Bacterial Meningitis
Cerebral Ischemia
Subdural Hematoma
Brain Tumor
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21
Q

Seizure etiologies

A 
Alcohol associated
Metabolic
Infectious
Trauma
CVA
Sleep Deprivation
Noncompliance with anticonvulsant
First time idiopathic seizures
22
Q

Status Epilepticus Etiologies

A 
Hypo-natremia, -calcemia, -glycemia
CNS abscess
Meningitis/Encephalitis
Neoplasm
AV malformations
Actue hydrocephalus
Intracerebral hematomas
CVA
TCA's
Migraines
Failure to take anticonvulsant
23
Q

Seizure management

A 
Airway
Thiamine (alcoholic)
Hx of patient
Establish IV
1st- Benzodiazepines
2nd- Phenytoin, Phenobarbital
Possible dextrose bolus, Narcan
24
Q

SE of Phenytoin

A

Hypotension

Bradycardia

25
Q

SE of Phenobarbital

A

Sedation
Respiratory Depression
BP depression

26
Q

Post-ictal state

A

Sleepy/confused
Often incontinent
Tongue bitten

27
Q

Vertigo Etiologies

A

Central
Somatic
Peripheral

28
Q

Central vertigo etiologies

A 
Migrainous
Brainstem ischemia
Cerebellar infarction
Cerebellar hemorrhage
MS
29
Q

Somatic vertigo etiologies

A

Panic attack

Weak, dizzy, nearly fainting patient

30
Q

Peripheral vertigo etiologies

A 
Benign paroxysmal positional vertigo
Vestibular neuritis
Herpes zoster oticus
Miner's disease
Labyrinthitis
Perilymphatic fistula
Acoustic neuroma
Aminoglycoside toxicity
Otitis media
31
Q

How long does peripheral vertigo etiologies last?

A

Few minutes to 3 hours and are recurrent

32
Q

How long does central vertigo etiologies last

A

Hours to days

33
Q

Define TIA

A

Brief stroke-like attack

Most symptoms last 5-20 minutes

34
Q

Symptoms of TIA

A 
Hemiparesis, hemiparesthesia
Dysarthria, dysphagia, diplopia
Circumoral numbness
Imbalance
Monocular blindness
35
Q

Define CVA

A

Sudden loss of focal brain function

36
Q

Types of CVA

A

Hemorrhage

Ischemia

37
Q

Types of Hemorrhage CVA

A

Subarachnoid hemorrhage

Intracerebral hemorrhage

38
Q

Types of Ischemic CVA

A

Thrombosis
Embolism
Systemic hypotension

39
Q

Positive signs of CVA

A

Indicate active discharge from CNS neurons

Visual, auditory, somato-sensory, motor

40
Q

Negative signs of CVA

A

Indicate absence or loss of function

Loss of vision, feeling, or ability to move a part of the body

41
Q

CVA management

A

Ensuring medical stability
Reversing conditions contributing to condition
Uncover pathophysiologic basis of symptoms
Screen for contraindications for TPA

42
Q

Immediate studies for CVA management

A 
Noncontrast CT
EKG
CBC with differential
CMP
PTT, PT, INR
Oxygen Saturation
Pregnancy test
Blood cultures if fever
43
Q

CVA treatment

A 
Keep patient flat to 15 degrees
BP between 140-160 to help perfuse
Reverse effects of warfarin (hemorrhagic)
TPA
Antithrombotic therapy
44
Q

Define Myasthenia gravis

A

Disorder of neuromuscular transmission affecting the ocular, bulbar, limb, and respiratory muscles

45
Q

Management of Myasthenia gravis

A

Monitor FVC every 1-2 hours
Elective intubation
Plasmapharesis or IVIG

46
Q

Define MS

A

Acute exacerbations that result in functionally disabling symptoms with objective neurologic impairment

47
Q

Treatment of MS

A

High dose IV glucocorticoids

Treat seizures if they occur

48
Q

Neuropathic Pain Syndromes

A

Determine if anything new or different about the pain being experienced

49
Q

Treatment for neuropathic pain syndromes

A

IM dose of deluded or morphine
1 time PO opioid
Start/increase prophylactic med
Regular follow up with PCP or pain specialist

50
Q

Guillian-Barre Syndrome

A

Symmetric ascending muscle weakness from the legs up
Severe back pain
Dysautonia

51
Q

Guillian-Barre Syndrome Diagnosis

A

Lumbar puncture
EMG
Nerve conduction studies

52
Q

Guillian-Barre Syndrome Treatment

A

Watch for respiratory failure
Monitor heart rhythm, pulse, and BP
Fluids
Admission to ICU

Neurology (10 decks)

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